Differential Diagnosis for Low Albumin and Elevated Gamma Globulin, Alpha 1 Globulin on Electrophoresis

• Single Most Likely Diagnosis
  • Nephrotic Syndrome: This condition is characterized by heavy proteinuria, hypoalbuminemia (low albumin), and often hyperlipidemia. The low albumin level is due to the loss of albumin in the urine, while the gamma globulins and alpha 1 globulins may be relatively increased due to their larger size, making them less likely to be lost in the urine.
• Other Likely Diagnoses
  • Chronic Liver Disease: Liver dysfunction can lead to decreased albumin production and increased production of gamma globulins and alpha 1 globulins as part of the acute phase response. Conditions like cirrhosis can cause these changes.
  • Inflammatory Conditions: Chronic inflammatory diseases (e.g., rheumatoid arthritis, chronic infections) can lead to increased production of gamma globulins (due to chronic antigen stimulation) and alpha 1 globulins (as part of the acute phase response), while albumin levels may decrease due to the negative acute phase response.
• Do Not Miss Diagnoses
  • Multiple Myeloma: Although less common, multiple myeloma is a critical diagnosis not to miss. It can present with an increase in gamma globulins (monoclonal gammopathy) and potentially decreased albumin levels. The key is to look for a monoclonal spike on electrophoresis.
  • Amyloidosis: This condition involves the deposition of abnormal proteins (amyloid) in various tissues and can lead to nephrotic syndrome or liver dysfunction, resulting in low albumin and potentially elevated gamma globulins and alpha 1 globulins.
• Rare Diagnoses
  • Alpha 1 Antitrypsin Deficiency: A genetic disorder leading to low levels of alpha 1 antitrypsin, which can cause liver disease and potentially affect albumin and globulin levels.
  • Certain Genetic Disorders: Some rare genetic conditions can affect protein production and metabolism, leading to abnormal electrophoresis results.